聚桂醇联合组织胶治疗食管胃静脉曲张后门脉血栓形成的预测

Prognosis of the portal vein thrombosis after lauromacrogol and cyanoacrylate treatment for esophageal and gastric variceal bleeding

目的分析内镜下聚桂醇联合组织胶治疗食管胃静脉曲张预防再出血后患者门脉系统血栓形成的危险因素,建立预测模型并验证该模型的准确率。方法收集2014年1月至2018年12月就诊于北京地坛医院的303例肝硬化并发食管胃静脉曲张破裂出血患者,对其行内镜下聚桂醇联合组织胶治预防再出血,随访观察1年,分析其中223例患者的临床资料,包括年龄、性别、病因、生化指标、Child-Pugh评分、静脉曲张程度、门脉血管宽度等指标。Logistic回归分析筛选出治疗后血栓形成的独立危险因素,并建立预测模型,应用80例患者的临床资料验证该预测模型的准确率。结果223例患者中1年内门脉血栓形成55例(24.66%),Logistic回归分析显示,左支门脉宽度(OR=1.414,95%CI:1.209~1.654,P=0.000)、右支门脉宽度(OR=1.267,95%CI:1.108~1.447,P=0.000)、食管静脉曲张程度(OR=2.033,95%CI:1.284~3.217,P=0.000)是治疗后血栓形成的独立危险因素,联合3个危险因素建立预测模型,得到ROC曲线下面积为0.862,cut-off值为-2.005。80例患者行交叉验证,该预测模型的准确率为95.0%。结论重度食管静脉曲张、左支门脉及右支门脉的宽度增加是治疗后形成血栓的高危因素,三者拟合模型预测血栓形成率准确率可达95.0%,具有一定的预测价值。

Objective To establish the predictive model of portal vein thrombosis after lauromacrogol and cyanoacrylate therapy for recurrent bleeding of the patients with esophageal and gastric varices,and then evaluate the accuracy of the predictive model.Methods A total of 303 patients with esophageal and gatric variceal bleeding were admitted to Beijing Ditan Hospital from Jan.2014 to Dec.2018,who underwent the lauromacrogol and cyanoacrylate therapy for rebleeding.A retrospective analysis in 223 cases of them was performed for their demographic data and disease characteristics,including sex,age,biochemical markers,Child-Pugh score,and grade of varices,diameters of the portal vein,etc.A multivariate Logistic regression analysis was performed,and then the predictive model was established.Clinical data of 80 cases were evaluated to the accuracy of the model.Results 55 cases with portal vein thrombosis were happened after endoscopic treatment during 1-year follow-up,and the incidence of thrombosis was up to 24.66%.The multivariate Logistic regression analysis showed that diameter of left branch of portal vein(OR=1.414,95%CI:1.209-1.654,P=0.000),diameter of right branch of portal vein(OR=1.267,95%CI:1.108-1.447,P=0.000),the grade of esophageal varices(OR=2.033,95%CI:1.284-3.217,P=0.000)were the independent risks of thrombosis.Combined these risks to establish a predictive model,an area under ROC curve was 0.862 and cut-off was-2.005.Verification with the clinical data of 80 cases,the accurate rate of the model was 95.0%.Conclusion Severe grade of varices,the diamenters of right and left branch of portal vein indicated high risk of portal vein thrombosis.The predictive model of thrombosis by 3 risks established had 95.0%accuracy.